Recently, the Senate approved a significant rule change which eliminates the use of the filibuster on all Presidential nominees except for the U.S. Supreme Court. In a nutshell, the Senate’s passage of the so-called “nuclear option” now allows executive branch and judicial nominations to be approved with a simple majority – 51 votes — rather than the 60 votes that was previously required.
Certainly, the decision to go “nuclear” will make bipartisan deals more difficult to attain and it may result in a shift of power away from the legislative branch and to the executive. With this in mind, it begs the question how will the decision to go “nuclear” effect the nomination of individuals to the Independent Payment Advisory Board (IPAB)?
For those folks who might be new to this topic, the IPAB was created by the Affordable Care Act (ACA), and is a board of 15 unelected and largely unaccountable government bureaucrats whose primary purpose is to cut Medicare spending. In order to serve on the IPAB, nominees have to be confirmed by the Senate, and with the newly invoked “nuclear option,” the confirmation process is theoretically much easier.
To this end, we wanted to highlight two outstanding articles written on this very topic:
- Sam Baker of the National Journal makes the case that the “nuclear option” does in fact breathe new life into the IPAB by making it much easier for President Obama to appoint its 15 members.
- Michael Cannon with Forbes raises a very valid point and discusses that although the “nuclear option” makes the process of appointing people much easier for the President, Obama doesn’t need to appoint anyone to the board. If the IPAB fails to make Medicare recommendations, for whatever reason, then the HHS secretary is empowered to submit her own plan in lieu of the IPAB.
The bottom line is this: Whether the IPAB allows the HHS Secretary or 15 unelected and largely unaccountable government bureaucrats to arbitrary cut Medicare spending, the outcome will be the same — seniors will have less access to care.
We have said it before; bad policy is just bad policy. IPAB, coupled with the “nuclear option,” really only accomplishes one thing: adding a can of worms to bad policy. This is exactly why organized neurosurgery continues to press Congress to repeal the IPAB, which in the future will STILL have the power to haphazardly cut billions of dollars from Medicare.
On Halloween, the Senate Finance and House Ways and Means Committees released a bipartisan, bicameral draft proposal to repeal and replace Medicare’s sustainable growth rate (SGR) formula. The proposal would permanently repeal the SGR update mechanism, reform the fee-for-service payment system through greater focus on value over volume, and encourage participation in alternative payment models. Although this framework attempts to solve the SGR problem, it still far from the Superman approach we need. Key provisions in the draft include:
- Repeal the SGR formula;
- Freeze annual fee schedule payment updates for 10 years, with positive updates beginning in 2024;
- Avoid payment differentials between primary care physicians and specialists;
- Combine Medicare’s current incentive and penalty programs, including the Physician Quality Reporting System (PQRS), Electronic Health Record (EHR), and Value-Based Payment Modifier (VBPM) programs and penalties, to create a single budget-neutral program for evaluating physician performance;
- Establish a new “value-based performance (VBP) payment program,” which would adjust payments beginning in 2017;
- Allow physicians to participate in alternative payment models, such as accountable care organizations, rather than the VBP payment program;
- Require an assessment of medical services, including the global surgical package, to “ensure accurate valuation of services” under the physician fee schedule; misvalued codes would be adjusted to achieve roughly $3 billion in total fee schedule savings;
- Instruct the Secretary of the Department of Health and Human Services (HHS) to require physicians to submit data on resource use or face a one-year, 10 percent payment reduction;
- Utilize appropriate use criteria for certain imaging services—prior authorization requirements would be imposed on physicians ordering too many tests and
- Direct the Department of Health and Human Services to publish utilization and payment data for physicians on the Physician Compare website.
At this point, the AANS and CNS have significant concerns about this proposal, as outlined in our comments to the committees. Although the bipartisan plan repeals the SGR, it also creates a budget neutral system that pits doctors against each other, creating winners and losers. At the end of the day, everyone agrees that the SGR needs to go, but we must be careful what we ask for because if the cure is as bad or worse than the disease, we haven’t solved the problem.
Posted in Congress, Health, Health Reform, Healthcare Costs, Medicare, Quality Improvement, SGR
Tagged EHR, Electronic Health Record, HHS, House Ways and Means, Physician Compare, Physician Quality Reporting System, physicians, PQRS, Senate Finance, specialists, sustainable growth rate, Value-Based Payment Modifier, VBPM